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Topic: Why isn't hormesis more popular? (Read 6985 times)

I think there are 3 barriers to hormesis really taking off in the medical field.

1. Reimbursement doesn't support it (meaning it doesn't fit the current business model of medicine-and I don't expect that to change as medicine becomes more socialized.

2. Patients don't expect it.

3. Patients often times don't want it. Currently I am a pathologist, which means that I don't treat patients at all, so this is somewhat academic. But previously, I was a family doctor. Although I wasn't aware of all the aspects of hormesis that you have brought out, I did know that type 2 diabetes could be quite effectively treated with aggressive modification of diet and exercise. But very few of my patients would actually do it (I can't actually think of any). Also, since starting this eye therapy program, I have told many people about it. Lots have told me that they think it is great, but very few have tried it themselves. Most say that they just aren't disciplined enough. Contact lenses are an instantaneous and fairly good solution, and most people seem happy with that-after all, they did work for me for about 30 years.

I do think you have some great insights, though. I've tried the cold showers and some intermittent fasting-they work. I have recommended the cold showers to several people going through emotional problems-and it really has helped them. If you ever do get around to writing book I'd like to help you with it.

I did read "The Brain that Changes Itself"-on your recommendation. Quite a good book.

Now I have a recommendation for you-"Anatomy of an Epidemic" by Robert Whitaker. It is quite well written and documented and very readable. It is about the epidemic of mental illness in America. He makes the case that much of the mental illness we currently see is the body making a normal, adaptive response to psychiatric medications. I sent you a couple of articles about this some time back. Basically, when placed on a medication that alters neurotransmitters (whether dopamine, serotonin, or whatever), there is an initial therapeutic response. But over time, the body "reads" this as an abnormal signal, and down regulates, up regulates, or adjusts to compensate-which turns an acute illness into a chronic one.

It's quite a good book. While not exactly what you write on-using stress to promote health, it really is about therapy causing illness (anti-hormesis?)-but the underlying biologic principles are the same. I think it directly applies to what you write about. I think it is the most significant book I have read as a physician. As doctors, we should always be very aware of the very real possibility that our therapies might cause harm. Especially when the initial treatment cures the disease-the body might make a long term adaptation to the therapy which makes things worse.

Excellent post, Nate. I really appreciate your thinking on this topic, and the 3 points you make are quite plausible. I especially like your observation that apparently effective short term therapies need to be scrutinized for their potential "anti-hormetic" long term effects. In that light, and on your recommendation, I will pick up a copy of Whitaker's book. I do think that the limited success of antidepressant therapies is one of the dark secrets of the psychiatric profession. While antidepressants may help some people, I think their benefits have been oversold.

I take hormesis mean the taking of actions - that you would not normally take. For instance, "cold showers", or "diet" of any sort. All these items are special and require good intelligence and MOTIVATION in the person to do correctly and successfully.

I make no "great claims" for myself, except that I investigate my own "bad habits", as a young person, and the consequences to me, and others for that "bad habit". This is why I searched out medical people who argued for prevention (in the case of threshold myopia prevention - which makes logical sense and is reasonable - to me at least).

The result of that research was that I attempted to help a pilot, Brian Severson - who had the intense motivation to do it RIGHT. (But he followed my instructions - with great intensity.)

The result of that, was his book on the subject, that Todd obtained and followed. The result of that was that Todd got his distant vision back, because the book made logical sense to him.

All the above comes from being aggressive about one's intellectual ability, and listening to those in medicine who had developed the "contradictory" idea, that perhaps few can understand and commit to.

But, to me it is very clear that you can not prescribe it. I do think that a real advance will come from doctors like Nate, who will learn enough about this issue to help their own children "avoid" or prevent.

I look for the day when people like Todd and Nate can organize a "clean" preventive study, based on Todd's success. This does require intense effort, and few people are willing to follow that effort. I would never call success here to be a medical success. It must a always become a personal success. That is the true issue of prevention - in my opinion.

I think there are 3 barriers to hormesis really taking off in the medical field.

1. Reimbursement doesn't support it (meaning it doesn't fit the current business model of medicine-and I don't expect that to change as medicine becomes more socialized.

2. Patients don't expect it.

3. Patients often times don't want it. … very few of my patients would actually do it. … Most say that they just aren't disciplined enough.

These all sound to me like great observations. Here are two more:

1. I'm thinking that hormesis is actually very popular outside of a "scientific" context. Pretty much everyone thinks that facing adversity, exerting yourself, practice, willpower, self-discipline, overcoming progressively more-difficult obstacles, etc. build skill, character, and toughness. Pretty much everyone thinks that too much comfort makes you lazy and soft. It's really not controversial. Whether it's jogging, weightlifting, learning math, practicing piano, or getting good at a video game, hormesis is pretty much the default way that people think about improvement. The word "hormesis" is not widely known, but the idea is.

2. In grad school, I've had an up-close look at how scientists usually study things. They're looking for independently measurable input factors to correlate against independently measurable output factors. They don't want to deal with complicated interactions between many simultaneous factors, because the statistics are much harder to deal with. And, no matter what they say about statistics trumping everything, they tend not to take an idea seriously unless there is a known mechanism involving a very specific chain of events, one part of the system affecting the next, through which a cause produces its effect. They prefer to look at first-order effects; second-order effects are much harder to research and understand.

Eyeglass prescriptions give instant results that are easy to measure and prove. It's fairly easy to measure and prove the short-term effects of drugs. The effects of long-term medication are actually very hard to measure, but at least there are only a few input factors to control (drug, diagnosis, and maybe a couple other easily specified factors, like weight, age, and gender).

The mechanism of eyeglasses is straightforward optics—that they produce their effect and how they produce their effect are known with utter certainty. Most drugs actually don't have well-understood mechanisms of action, but at least there's a story to explain how they work in terms of very simple factors: "cholesterol clogs your arteries, therefore don't eat as much cholesterol (or take a drug that interrupts the metabolic pathway that produces cholesterol)"; "schizophrenia is caused by too much dopamine, therefore take a drug that clogs up your dopamine receptors"; "depression is caused by not enough serotonin in your synapses, therefore take a drug that clogs the re-uptake of serotonin"; "you don't have enough vitamin D, therefore take supplements"; etc.

Hormesis seems like a "whole-body" phenomenon. It's hard to figure out the mechanism by which hormesis works. It involves perturbing a vast network of feedback loops all at once. Hormesis is by definition a second-order effect. The first-order effects of acute stresses are obvious, easily measurable, and always bad. So, hormetic effects live in a blind spot of most scientific research.

Still, all the different forms of hormesis do seem extremely amenable to straightforward empirical tests and measurements. This "blind spot in science" sure looks like a surmountable obstacle.

Subject: There is a "school of thought" that ONLY a medical person, MUST do everything for us. I simply do not agree.

Discussion: From the wise ODs who talked to be about science, it became very clear that "they" could never help me, so I had to develop the scientific knowledge to help myself.

Nate has intimated this in many ways. I spell it out exactly. But I "personally" draw a line between OBJECTIVE scientific knowledge of the behavior of all natural eyes (that we can discuss - and not involve medicine) and then recognize that a medical-man in an office, can only quick-fix us (the ignorant, not motivated public) with a minus lens.

All of this depends on how you define science. Science does not "fail", but most of us FAIL to understand science.

Torvald> Hormesis seems like a "whole-body" phenomenon. It's hard to figure out the mechanism by which hormesis works. It involves perturbing a vast network of feedback loops all at once. Hormesis is by definition a second-order effect. The first-order effects of acute stresses are obvious, easily measurable, and always bad. So, hormetic effects live in a blind spot of most scientific research.

Otis> The only change I would make would make "scientific research", into "medical research", with the idea that true-prevention requires real understanding of science, and the extreme pressure a "medical person" always comes under - if he attempts to change ANYTHING. I do not want that pressure - and I have no desire to put that pressure on a man in his office.

Torvald> Still, all the different forms of hormesis do seem extremely amenable to straightforward empirical tests and measurements. This "blind spot in science" sure looks like a surmountable obstacle.

Otis> Hormesis is indeed open to scientific proof, and proving the natural eye is dynamic, is part of that process. I personally will only say, "self-measured change of refractive state", and limit that statement to about -1.0 diopters, and 20/50 to 20/60 on your own Snellen. I do not see successful prevention (as Todd did it) as ever being a process any one in medicine can ever prescribed.

Otis> I also believe that the ONLY person who believes that he was successful, is the person who actually, "did it himself". This makes this preventive process, genius dependent, where Todd is the genius who actually did it.

In grad school, I've had an up-close look at how scientists usually study things. They're looking for independently measurable input factors to correlate against independently measurable output factors. They don't want to deal with complicated interactions between many simultaneous factors, because the statistics are much harder to deal with.

....Hormesis seems like a "whole-body" phenomenon. It's hard to figure out the mechanism by which hormesis works. It involves perturbing a vast network of feedback loops all at once. Hormesis is by definition a second-order effect. The first-order effects of acute stresses are obvious, easily measurable, and always bad. So, hormetic effects live in a blind spot of most scientific research.

Still, all the different forms of hormesis do seem extremely amenable to straightforward empirical tests and measurements. This "blind spot in science" sure looks like a surmountable obstacle.

Interesting observations, Torvald. To paraphrase, you are suggesting that reductionism is the dominant mode of conventional science, while an adequate account of hormesis requires a holistic perspective that incorporates feedbacks and other second-order effects. And reductionism is the favored model because it is more straightforward to test reductionistic hypotheses. Immediate or short term cause and effect are treated as linear, and are easier to isolate.

I have a few comments about this thesis:

1. While the statistics are easier for linear models, the mathematics and computing power now exists for multi-variable regressions and non-linear regression analysis. And recent advances in non-linear mathematics is making the analysis of complex systems more tractable -- even complex biological systems with a lot of feedback. So there are fewer excuses these days for shying away from the analysis of complex systems.

2. Even given the homeostatic feedbacks and other second-order effects in biology, the changes and adaptations that arise from applying hormetic stresses are quite real and often large in magnitude. I would argue that in many cases they are just as measurable, and often more pronounced, as the short term effects of acute stresses.

Perhaps the most significant problem is that these second-order effects usually take more time to show up. And because they often impose short term costs and discomfort, it may be harder to design long term studies with human subjects willing to persist.

3. There is also the problem of biochemical individuality and differential adaptation. The dose and frequency that is hormetically beneficial for one person may be harmful or toxic to a second person, and yet inadequate for a third. So one can't specify a fixed dose and frequency for test group; instead the dose and frequency must be adapted to each test subject's starting condition, and probably modified as each subject adapts. The classic example would be weight lifting; it would be inappropriate to test the efficacy of a training program by having all subjects lift the same amount of weight. The training program must be customized. The same is true for any other application of hormesis -- from vision improvement, to diet, to developing cold tolerance.

Despite the above challenges -- as you point out quite well, Torvald -- it should be possible to design meaningful tests of the benefits of hormesis.

Thinking about this some more, there are some excellent examples of good scientific research on hormesis:

1. Dose-response studies. Academic researchers such as Edward Calabrese and Suresh Rattan have published classic studies of chemical hormesis. They have surveyed and compiled a convincing range of data on the hormetic dose-response behavior of numerous compounds across many microbe, plant and animal species. I've linked several of these studies under the "Hormesis" links on my blog front page. Here is a good survey article by Calabrese:

2. The opponent process theory. A beautiful example of how one can study the feedback and second-order effects associated with hormesis is Richard Solomon's paper on the opponent-process theory. The paper lays out the theory in a clear and testable form, and then proceeds to supply the supporting evidence from tests with animals and humans. What's particularly nice is that the paper illustrates how hormesis causes a quantifiable adaptive effect that changes with time, and also with the magnitude and frequency of the stimulus. And offers a simple model that explains why these effects occur!

Here are some remarks by Dr. Alex Frauenfeld, that I consider very important. In all my research I am always interested in their point-of-view. Since Dr. Frauenfeld has helped people get out of nearsightedness, (i.e., pass the required DMV test, objectively), I think we must understand his perspective.

++++From Dr. Alex:

My father was exploring these types of avenues back in the 1970′s.

We found quite a few parallels in effectiveness in these types of studies, despite the different species used. I don’t have much in the way of recommendations for this though, for a simple reason:

We recognized that most people have a limited attention span for yet another project in their lives. The most potent long term results came from finding the fewest, most effective practices, and refining those for maximum effectiveness. With those parameters, we had the ingredients to help define small lifestyle changes, and persistent habits, which yield the most in terms of permanent eyesight improvement.

I am always interested in exploring new avenues, and it was a delight to see this type of discussion come up in the forum.

I may not always be adding much value to these types of discussions, just because of the nature of my efforts – time is limited, requiring me to specialize (as described above), to hopefully be the most effective resource for the largest number of people.

If you choose to experiment further, please do share your findings

+++++Otis> The "standard belief" in medicine that EVEN MILD PREVENTION is impossible. That is where I "draw the line". I think prevention is possible, but it is an "intrusion" in your life-style. For me, I accept that it must be that way, and, must mean a serious change (while still at 20/50). More on this in due course.

1. While the statistics are easier for linear models, the mathematics and computing power now exists for multi-variable regressions and non-linear regression analysis. And recent advances in non-linear mathematics is making the analysis of complex systems more tractable -- even complex biological systems with a lot of feedback. So there are fewer excuses these days for shying away from the analysis of complex systems.

Interesting point. (Not the only one, of course.) I've usually been skeptical about applying statistics meaningfully to systems that are dominated by uniqueness, since you can't extrapolate from a sample to a population unless the whole population is somehow "all alike". But it must be do-able somehow, or we couldn't apply what we've learned from one unique person to understanding other people, even at the level of everyday observation—which works very successfully. New advances in statistics could really open the door to rigorous testing of what previously we'd have to consider "irreproducible results".

I'd ask you to suggest a paper that applies non-linear statistics to a complex system with gobs of internal feedback, but I'm already pretty deluged in reading papers right now. I'm now taking a class on "mathematical psychology": clever yet simple ways to milk insight into psychological/computational processes from measurements of externally visible responses to stimuli. Even just looking at first-order effects is taxing my brain aplenty right now.

First - I congratulate you on your success - and the ability to REJECT the wearing of a minus and embrace (successfully) the wearing of a plus - for the long-term. Tragically, most people are given a strong minus, and have no idea that an (early) preventive plus can be effective for them.

Second - For me, personally, in my long-term search, I begin to realize (with shock) that an optometrist could be of no help to me - and that I would have to teach myself how to (avoid) entry. That truth comes out of Dr. Young's five year study of the effect of a (properly used) plus on a child. This "situation" (of stair-case myopia) must be stopped, by the person himself, before he goes below 20/40 (on his own Snellen). I would agree that true-prevention is a "secondary effect" of the actions of a wise person.

++++

Todd> 2. Even given the homeostatic feedbacks and other second-order effects in biology, the changes and adaptations that arise from applying hormetic stresses are quite real and often large in magnitude. I would argue that in many cases they are just as measurable, and often more pronounced, as the short term effects of acute stresses.

Otis> The "plus" on a person with 20/60 does produce a "short-term" effect, sometimes to 20/30 and better. That is indeed objectively measured by the person himself - and allows him to pass the required driving test.

Todd> Perhaps the most significant problem is that these second-order effects usually take more time to show up. And because they often impose short term costs and discomfort, it may be harder to design long term studies with human subjects willing to persist.

Otis> It would be hard to described, "short-term costs". When correctly understood (you do it yourself) the short-term costs are about $10 for a plus lens, and perhaps $10 for a minus lens (you get it yourself - for emergency use only). The discomfort is in two parts. You (incorrectly) think that you are conducting "medicine" on yourself. I say that is not true - but that is a judgment a person must make. The second part is wearing a plus for near. I find it very relaxing - and no problem at all and with no "fear" in me.

Otis> The last part, "design a long-term study" (with the issue of WHO IS IN CONTROL) is most important for pure science. With highly motivated engineers (like both of us), it would succeed, based on Dr. Young's seminal study - as published and reviewed. You were successful because you UNDERSTOOD, and did what was necessary. Most engineers believe in "doing it yourself" - because no one is going to do it for you. It is that type of person, in an organized study, the will succeed - if he greatly values his distant vision.

What you have said about the "no interest" of the general public "rings true". I have included your remarks on this proposed statistical study of pilots wearing a plus (at 20/50) to slowly get out of it.

We know the basic science of the natural eye's behavior. We know from a "plus" study the probable "Standard Deviation" or Sigma of all groups. It is obvious prevention is not possible for a child - and for all the reasons you state - not possible for medicine either.

But with minimum extrapolation of the basic data, there is reason to believe that all the pilots at 20/40, could get to 20/20 in about six to nine months. But this could never be a "blind study". Far from it, you would have to tell BOTH GROUPS all that is known about the eye's proven behavior, and INSIST they make all the measurements themselves.

If you want a person to BELIEVE his own results - force him to make all the measurements - which you can to with an engineer or scientist. If fact, I would expect most of them to rise to the challenge when they understood that they were going to be scientific leaders. The person's intense motivation and curiosity must be part of that "equation". This could never be conducted as a "medical study", with unreasonable "protocols" that would destroy the study - before it could even start.

Subject: Why an optometrist who discovers the truth (plus-prevention works at 20/50), can not help.

There are ODs and MDs who "wake up" to the wisdom of wearing the plus (as prevention), rather than "cure". I often wondered about that issue. For those professionals who do, they find that the, "...parents will not stand for it".

In fact I agree with him. The only question is the wisdom of the person himself, when he still can read the 20/50 to 20/60 line. Certainly you can not expect a "medical person" to help under this tragic situation. The statistics show our eyes "going down" at a rate of -0.66 to -0.5 diopters from age 5 to 17. The data shows the "plus" is effective - if used early. But when it comes to presenting the concept - in an office - then a parent will not "stand for it".

This is not a "complaint" by me. It just recognizes that if you wish plus-prevention, you must be wise enough to do it yourself.